Everything You Need to Know About Mediclaim Insurance

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Everything You Need to Know About Mediclaim
Policy
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Introduction

• Mediclaim policy has come into being to provide
  medical insurance cover to you and your family.
• A Mediclaim policy covers costs for your medical
  treatment.
• It takes care of your medical expenses in the
  below scenarios
• Sudden illness or injury
• In case of accident
• Hospitalisation required due to surgery

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Features of Mediclaim Policy

• Can be opted by anyone between the age of 91
  days-65 years.
• Pre-existing diseases are covered after a waiting
  period of 3-5 years.
• It can be purchased online without any paperwork.
• Can be opted as an individual or family floater
  plan.
• Sum assured can be above 50 lakhs.

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How is premium of a Mediclaim policy determined?

• The premium for Mediclaim policy is determined on
  the basis of
• Age
• Sum insured
• Geographical location
• Pre-existing medical condition
• Extent of coverage
• Note You will be charged high premium

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Things to Consider While Buying a Mediclaim
Policy

• Sum insured/coverage amount
• Sum insured is the amount of medical coverage
  that your insurer will provide you at the time of
  hospitalisation.
• While choosing the sum insured, consider the
  rising healthcare costs and rate of inflation.
• Individual or family floater
• Mediclaim policies are of two types
• Individual-This type of policy provides coverage
  only to the policyholder.
• Family floater- This type of family floater of
  medical policy provides coverage to all the
  members of the family including you, your spouse
  and kids.
• Few plans also allow you to add your parents and
  in-laws.

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• Sub-limit
• A room rent limit is an amount specified by your
  insurer for you to occupy a room in a hospital on
  a 24 hour basis.
• Co-payment
• Co-payment is the percentage of amount that a
  policyholder is required to pay at the time of
  claim settlement of the medical expenses.
• Having a high co-pay limit attracts low premium.

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• Network of hospitals
• Insurers have a network of hospitals at which you
  can avail cashless treatment.
• Always check the number of hospitals covered
  under your hospitals network. More the number of
  hospitals covered, better for you.
• Exclusions
• Check all the exclusions of your insurance policy
  to be aware of all the terms and conditions and
  also the list of diseases excluded.
• Few insurers do not cover conditions arising out
  of HIV infection, congenital disease, alcohol
  addiction or drugs, suicide attempt, etc.

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How to claim on Mediclaim policy?

• If youre hospitalised at the hospital that
  falls/ comes under the network of your insurer
  then contact TPA (Third Party Administrator) at
  the time of admission at the hospital.
• You will have to submit all your medical reports
  to avail this facility.
• Availing cashless treatment facility means the
  insurer/ TPA directly settles your bills with the
  hospital.
• If youre hospitalised at the hospital that does
  not come under your insurers network, then
  youll have to go through the reimbursement
  process where in you will have pay the hospital
  bills first and then your insurer will reimburse
  it.
• Recommended Read Mediclaim Policy in India